ACT in College Counseling -- Book Interview

In this interview (2013), psychologist Dr. Jacqueline Pistorello discusses the latest research on challenges faced by college students, as well as new attempts at supporting them with mindfulness and acceptance interventions. In her recently editted book, Mindfulness and Acceptance for Counseling College Students, Pistorello and others explore how mindfulness and acceptance-based approaches such as acceptance and commitment therapy (ACT), dialectical behavioral therapy (DBT), mindfulness-based cognitive therapy (MBCT), and mindfulness-based stress reduction (MBSR) are being utilized in higher education settings around the world to treat student mental health problems like severe depression, substance abuse, and eating disorders, and/or to help students thrive--both in and out of the classroom.

Q: Are college students more distressed these days?

For adults whose idea of college is this carefree time full of fun and little adult pressures, the current statistics on college mental health may be startling. Suicide is one of the leading causes of death among college students (Suicide Prevention Resource Center, 2004). Over 20% of college students have seriously considered suicide and 8% have attempted it in their lifetime (American College Health Association (ACHA), 2012). Non-suicidal self-injury (NSSI) is also prevalent: 15.3% have engaged in it in their lifetime and 6.8% in the past year (Whitlock et al., 2011). Nearly 50% of college students have a diagnosable psychiatric disorder (Blanco et al., 2008); one in five has suffered from depression and two out of three have experienced overwhelming anxiety in their lifetime (ACHA, 2012). Severe drinking problems are common, with one third engaging in binge drinking (Wechsler & Kowalik, 2005) and 20% experiencing an alcohol use disorder (Blanco et al., 2008); college students are more likely to drink and drive, to engage in binge drinking, and less likely to seek treatment for substance abuse, than their college-aged counterparts in the community.

The question of whether this is an actual increase in pathology is being debated, but the data are compelling. One study examined birth cohort increases in psychopathology among young Americans and demonstrated that American high school and college students reported a gradual increase of symptoms of psychopathology relative to previous generations over the last 70 years, with the current generation of young adults scoring about a standard deviation higher on clinical scales. University counseling center directors overwhelmingly state that the number of college students seeking mental health treatment for serious concerns at counseling centers is increasing. One study showed that the percentage of students presenting with depression, suicidality, and personality disorders doubled within a decade (Benton, Robertson, Tseng, Newton, & Benton, 2003).

Q: Do we need to think differently when treating college students specifically? Aren't college students the same as adolescents or adults, depending on their age?

Traditional college students fall into a special category developmentally. The period between the ages of 18-26 has recently been coined as “emerging adulthood” (Arnett, 2000). This age bracket encompasses the majority of undergraduate students in Universities in the US and even abroad. Researchers have shown that this stage of development is different from adolescence, in that it is characterized by fast transitions into novel and varied social contexts bringing greater freedom and less social control than experienced during adolescence. College students face special pressures as well: a greater proportion live away from home and they are pressed to do well academically; to live up to parents’ expectations; to co-exist with other students, sometimes in very closed quarters; to become more comfortable with those who hail from different socio-cultural-economic backgrounds; to figure out where one stands in terms of sexual orientation, religion, politics, and so on. Thus, what may work with adolescents may not work with this population. Some studies have found, for example, that factors affecting the trajectory of substance abuse among adolescents differ for those in emerging adulthood.

In addition to developmental issues affecting traditionally aged college students, the treatment of students, traditional and non-traditional (students who return to college at an older age), within the context of a campus pose unique challenges. The “therapist” working at a College Counseling Center has a broader role than might typically be expected, balancing mental health and educational issues, balancing the student’s individual needs with campus safety, having to manage confidentiality in the context of parent phone calls, dealing with administrators’ inquiries, and so on.

Understanding how different approaches can be implemented with emerging adults and within a college context, can be very useful to clinicians and researchers alike. 

Q: We understand that you have an edited book coming out on mindfulness and acceptance in counseling college students, by New Harbinger. Why are mindfulness and acceptance important for college students?

That’s a great question. It used to be the case that people could limit their exposure to the amount and kind of information. These days, particularly because of technology, the world moves very fast (e.g., constant texting, Tweeting, rapid video games, multi-tasking) and we are bombarded with a steady stream of information, sometimes gruesome pictures that stay in our minds. We can probably all still picture the planes going into the Twin Towers or more recently, the two blasts during the Boston Marathon bombings. Social networks like Facebook also promote constant comparisons among young adults, and some of their most private matters, sometimes in the context of cyber bullying, may be revealed en masse in ways that cannot be taken back. Unlike those of us who are middle aged now, typical college kids are growing up this way, and we don’t know what effect this will have on their mental health. The research on experiential avoidance is virtually undisputed, suggesting that unless emergent adults learn ways to bring their attention back to this present moment and be able to “carry” difficult emotions, memories, urges, and thoughts, including perhaps constant self-judgments, the repercussions are likely to be dire.

Mindfulness and acceptance-based approaches have something to offer emerging adults that might very well not only be unique but utterly necessary given the current socio-cultural context.

Q: So, tell us a little about your book. What is it? What mindfulness approaches are discussed in it?

This is an edited “how to” book. It provides illustration of how different mindfulness and acceptance-based approaches are being utilized with college students. A thorough review of specific mindfulness based approaches with college students at this point would be premature. Although this is a burgeoning field, and more and more studies are being conducted every month, the empirical evidence specifically with college students is building. The book emphasizes ACT, it also provides exposure to how DBT, MBSR, MBCT, and Ellen Langer’s mindful learning can be applied with college students and/or campus settings. This book is primarily geared towards practitioners or researchers working with college students or young adults. However, the book may be useful for anyone trying to implement ACT or other mindfulness based approaches outside the more typical therapy setting. The chapters are diverse and some of the initiatives go outside the box and may be helpful to individuals who are entertaining applying ACT or mindfulness based approaches in different settings.

This is a practical guide. The chapters are written by extremely knowledgeable authors who are not just theoreticians but are "in the trenches" and know how to explain what works best in a very practical, step-by-step way. The book also includes an extensive online Appendix where protocols, Power Point presentations, and modifiable Word documents (e.g., group flyers) developed by chapter authors can be accessed; this can be a huge time saver. 

Q: What new research is included that will be of interest to the ACT community?

We do have some hot off the press research findings mentioned in this book, hailing from across the globe (Australia, Italy, England, and the United States), that will be of interest to the ACT community in general. For example, one of the chapters summarizes findings from a study comparing ACT and MBCT. Although there were almost no differences in outcome, the authors discuss which individuals may benefit more from each approach. Another chapter described ACT podcasts that were created for college students, and summarizes findings regarding the utility of ACT podcasts, relative to CBT podcasts; this study found that students listening to the ACT podcasts reported greater academic engagement (e.g., less reading/texting during classes). Another chapter described a transdiagnostic ACT group showing promising findings; although we often laud ACT for being a transdiagnostic approach, most published ACT research so far has focused on one specific diagnostic categories (e.g., depression, psychosis), whereas this open trial study included a range of anxiety and mood problems. Other chapters describing ACT have gone beyond the therapy room, such as applying ACT in various classroom settings (including infusing ACT into an Abnormal Psychology class or creating ACT seminars), towards the training of college student peer mentors, and via an online values intervention. The latter study showed that adding values training to an online goal-setting procedure led to statistically significant improvements in grades. The range of new approaches and methods is impressive and readers will have a lot of new ideas about how to best serve college students.